摘要目的 通过制作猪心肺复苏动物模型,于复苏后应用乌司他丁(UTI),评价其对心肺复苏后脑保护的作用.方法 雌性家猪20头,通过程控刺激法制作心室颤动动物模型,室颤8min后开始心肺复苏,恢复自主循环的家猪随机(随机数字法)分为两组:①UTI组,复苏后立即开始给予UTI,每次10万U溶于生理盐水5 ml,缓慢注射,每3h1次,直到复苏后24 h(第24小时不给药)；②对照组,复苏后应用生理盐水5 ml作为对照,给药时间和次数同实验组.分别于基础状态、复苏后即刻、复苏后3、12及24 h抽取家猪静脉血备用测定TNF-α和IL-1β水平.复苏后24 h行神经功能评分(CPC评分),然后处死家猪,留取脑组织进行普通光镜病理及超微结构检查.结果 20头家猪经过8 min心室颤动后复苏成功15头.复苏后UTI组(n=8)和对照组(n=7)实验猪均存活24 h.复苏后3、12和24 h UTI组的TNF-α和IL-1β水平明显低于对照组(均P＜0.05).UTI组家猪24 h CPC评分好于对照组(P＜0.05).24 h UTI组脑组织损伤程度明显轻于对照组.结论 复苏后应用UTI可以减轻脑组织损伤,改善脑功能恢复.

abstractsObjective To evaluate the effects of ulinastatin (UTI) on brain protection after cardiopulmonary resuscitation in a porcine model.Methods A total of 20 female swine were induced to make ventricular fibrillation (VF) by programmed stimulation method,and CPR was stared after 8 mins after VF.Swine after ROSC (return of spontaneous circulation) were randomly (random number) divided into two groups,namely UTI group and control group.In UTI group,UTI was administered slowly in a dose of 100 000 U dissolved in 5 ml saline immediately after resuscitation and then given every 3 h until 24 h after CPR (UTI not given at the time of 24 h) ; and 5 ml saline was used instead in control group.Venous blood samples were taken separately before VF,immediate after resuscitation and 3 h,12 h and 24 h after ROSC for detecting levels of TNF-o and IL-1β.Cerebral performance category (CPC) scores were assessed 24 h after ROSC,and subsequently the swine were sacrificed to get brain specimens for histopathological and ultrastructural examination under ordinary light microscope.Results Fifteen of twenty domestic swine were successfully rescued 8 mins after ventricular fibrillation.Swine of UTI group (n =8) and control group (n =7) were all survived over 24 h.Both TNF-α and IL-1β levels were significantly lower in UTI group than those in control group at intervals of 3 h,12 h and 24 h after ROSC (P ＜0.05).Twenty-four hours after ROSC,CPC scores of swine were higher in UTI group than those in control group (P ＜ 0.05).The brain injury 24 h after ROSC was significantly attenuated in UTI group than that in control group.Conclusions UTI can reduce the injury of brain tissue and improve the recovery of cerebral function after CPR.